BackgroundEndoscopic　bariatric　surgery　(EBS)　is　a　new　treatment　for　obesity.　We　compared　the　efficacy,　safety,　and　probability　of　metabolic　complications　of　different　EBSs　with　laparoscopic　sleeve　gastrectomy　(LSG).MethodsThis　systematic　review　and　network　meta-analysis　(NMA)　included　searches　of　PubMed,　Web　of　Science,　and　the　Cochrane　Library　from　January　1,　2017,　to　December　27,　2022,　to　find　comparative　trials　of　EBS　procedures　and　EBS　with　LSG.　We　performed　a　frequentist　model　NMA　to　summarize　the　evidence　and　ranked　the　interventions　according　to　SUCRA　scores.ResultsThe　search　for　this　NMA　yielded　14,160　articles,　of　which　18　eligible　trials　recruited　766,135　participants　for　procedures　including　LSG,　endoscopic　sleeve　gastroplasty　(ESG),　nonadjustable　intragastric　balloon　(NIB),　BioEnterics　Intragastric　Balloon　(BIB),　and　adjustable　intragastric　balloon　(AIB).　Definitive　evidence　suggests　that　LSG　is　most　effective　for　weight　reduction.　Compared　with　LSG,　NIB,　SMD　=　-0.49　[95%　CI　-0.79,　-0.18];　AIB,　SMD　=　-0.41　[95%　CI　-0.76,　-0.06]　and　ESG,　SMD　=　-0.31　[95%　CI　-0.33,　-0.29]　in　the　index　of　percentage　total　weight　loss　under　six　months.　In　terms　of　safety　outcomes,　ESG　had　the　lowest　incidence　of　adverse　events;　the　order　of　the　observed　incidence　of　adverse　events　from　small　to　large　was　ESG,　NIB,　AIB,　LSG,　and　BIB.ConclusionsESG　is　an　effective　and　safe　minimally　invasive　surgical　method　for　people　with　overweight　and　obesity.　Its　12-month　effect　is　better　than　that　of　NIB,　and　its　influence　on　lipid　metabolism　makes　it　more　protective　of　the　cardiovascular　system　and　liver.　PROSPERO:　CRD42022375343.